U.S. officials hope a nursing home vaccination program that began in earnest this week will pump the brakes on a climbing COVID-19 death toll that has afflicted society at large but continues to fall hardest on the frail and elderly, especially those in long-term care.
Vaccinators plan to hit 75,000 sites in total as part of a federal partnership with CVS and Walgreens that kicked off in select states Friday and is expanding to every corner of the country. They reached 238 facilities in a dozen states this week and will reach an additional 1,000 sites in 13 more states by next week, Army Gen. Gustave Perna said Wednesday.
“I see us multiplying capacity every day as we go and more vaccine becomes available,” said Gen. Perna, who oversees logistics for President Trump’s Operation Warp Speed vaccine initiative. “Every week, we’re just building that as we go.”
Long-term care facilities are ripe targets for COVID-19, which can sicken people of all ages but preys on the elderly and people with underlying medical conditions. Less than 1% of the U.S. population lives in long-term care, but these facilities have accounted for nearly 40% of deaths from COVID-19, at over 115,000, according to the COVID Tracking Project.
“The coronavirus-associated death toll amongst long-term care facility residents should begin to decrease significantly as more of the most vulnerable become immunized,” said Moncef Slaoui, science adviser for Operation Warp Speed.
He said the Pfizer and Moderna vaccines that are in circulation stiff-armed severe disease in human trials, so it would be reasonable to see a downward trend in deaths among the vaccinated population two to three weeks after they receive their shots.
Roughly 2,500 are dying per day overall in the U.S., on average, nudging the death toll from COVID-19 to a once-unfathomable 325,000. It’s by far the highest death toll in the world, although some question whether other nations such as China are as diligent or transparent in reporting COVID-19 mortality.
Government disease trackers say COVID-19 deaths don’t appear to be simply replacing deaths that might have occurred this year from other leading causes. Deaths from those other causes are on par with prior years and even higher in some cases.
“If COVID were simply displacing these other deaths, we’d likely see fewer deaths from heart disease, cancer, dementia, diabetes. That is not what we are seeing this year,” said Lauren Rossen, a mortality statistician at the National Center for Health Statistics.
Beyond nursing homes, which are largely populated by people older than 65, data shows death figures among those 35 to 65 inching up again. Numbers in that age group dipped after a “Sun Belt” spike in midsummer.
“In the last couple of months, young adults have contributed more to deaths. They’re still obviously much less apt to get sick, but because they’re out and about, they do contribute” to the toll, said William Schaffner, an infectious disease specialist at Vanderbilt University.
Prisons are another worry spot, prompting debate over their place in the pecking order for a vaccine. Federal data also shows 1,685 people in prisons have died from COVID-19, including nearly 100 staff members.
Joseph Bick, the director of health care services for the California Department of Corrections and Rehabilitation, said advisers to federal agencies should prioritize inmates in the vaccine rollout.
“Cases among staff and inmates are currently surging to unprecedented numbers, threatening to overwhelm local resources,” he told a Food and Drug Administration advisory panel last week.
For now, the vaccination effort will focus on people in long-term care. Roughly 80% of Americans who have died of COVID-19 were older than 65 and were either in or out of such facilities.
Despite efforts to test more frequently and protect the vulnerable, the virus continues to seep in as community transmission flourishes, with 4,525 deaths in long-term care in the week ending Dec. 6 — a 47% increase from the week ending Nov. 8, according to the Centers for Medicare and Medicaid Services.
“This is due to soaring spread in the surrounding community, which has ultimately led to record-breaking cases in nursing homes,” the American Health Care Association, a nonprofit that represents nursing homes, assisted living communities, and facilities for people with disabilities, said in an email to The Washington Times.
“While mortality rates decreased compared to the spring due to a better understanding of the virus, better treatments, and government resources to help reduce spread, as we predicted, the rising number of new COVID cases in facilities are resulting in an increasing number of deaths,” the association said.
“We are extremely hopeful this vaccine will literally be a lifesaver for thousands of residents and expedite the reopening of our facilities to family members and loved ones,” it said.
The effort will likely have hiccups as nursing homes deal with staff who do not want the vaccine or seek proxy permission from adult children of those with Alzheimer’s disease or dementia.
“There’s obviously issues with consent, issues with medical exemptions,” said Rachel Garfield, a vice president at the Kaiser Family Foundation and director of its program on Medicaid and the uninsured.
Still, she said, the campaign marks “a little bit of light at the end of the tunnel” after long-term care contributed an outsized share of U.S. deaths.
The U.S. case fatality rate, or share of people who test positive and then die, is steadily improving and down to 1.8%. That puts the country on better footing than Mexico (9%) and Italy (3.5%).
The case fatality rate is a slippery number, however. Widespread transmission creates a larger denominator that drives down the case fatality percentage, even as deaths across America rise.
“The sheer number of cases will translate, biologically, into a certain rate of death,” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.
The U.S. is recording about 99 deaths per 100,000 people, putting it roughly on par with Mexico (95) and France (92) but far worse than Germany (34), India (11) and South Korea (1.4).
New York state has lost the most residents in total — nearly 37,000 — and New Jersey has the biggest share of deaths of per 100,000 residents, at 206. In just the past week, Kansas and South Dakota have recorded the most deaths per 100,000 residents.
• Tom Howell Jr. can be reached at thowell@washingtontimes.com.
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